A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
- Inspection (viewing).
- Skin (upper and lower legs, ankle region, and feet) [Normal: intact; abrasions/wounds, redness, hematomas (bruises), scars)]
- Gait pattern (fluid, limping).
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint [abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment].
- In the presence of pain in the leg, esp. in the calf:
- Pain provocation if deep vein thrombosis (DVT) is suspected:
- Calf compression pain (Meyer’s sign); positive: tenderness on the medial side of the lower leg along the so-called Meyer’s pressure points (inner side of the upper lower leg).
- Calf pain on dorsiflexion of the foot (Homans sign); positive: calf pain on dorsiflexion of the foot (flexion toward the dorsum of the foot) with the leg extended.
- Foot sole pressure pain (Payr’s sign); positive: pressure painfulness, especially the medial sole of the foot, when pressure is applied to the sole of the foot with the fingers
- Pain provocation if deep vein thrombosis (DVT) is suspected:
- In the presence of edema (swelling) of the leg (see also under leg swelling (leg edema)):
- Skin color
- Redness (rubor)?
- Hyperthermia (calor)?→ If yes: indication of arthritis (joint inflammation) or activated osteoarthritis (inflammatory episode of degenerative joint disease).
- Cyanotic skin? (purple to bluish discoloration of the skin).
- Other changes
- Atrophic skin changes (loss of skin elasticity).
- Erythema (areal redness of the skin).
- Shiny skin
- Cold skin
- Cold sensation in the affected extremity
- Varicosis (varicose veins)
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Auscultation and palpation (palpation) of the abdomen (abdominal cavity).
- Inspection (viewing).
- Neurological examination – in case of neurological concomitant symptoms.
- Health check
Square brackets [ ] indicate possible pathologic (abnormal) physical findings. Wells score for determining the clinical likelihood of deep vein thrombosis (DVT).
| Symptoms | Points |
| Active or treated cancer in the last six months | 1 |
| Paralysis or recent immobilization of legs (e.g., cast immobilization) | 1 |
| Bed rest (> 3 days); major surgery (< 12 weeks). | 1 |
| Pain/ induration along the deep venous system | 1 |
| Swelling whole leg | 1 |
| Swelling of lower leg > 3 cm compared to opposite side | 1 |
| Indentable edema on symptomatic leg | 1 |
| Dilated superficial (non-varicose) collateral veins. | 1 |
| Previous documented DVT | 1 |
| Alternative diagnosis at least as likely as DVT | -2 |
| Clinical probability of DVT | |
| Low-risk group (cut-off of the sum value). | ≤ 1 |
| High-risk group (cut-off of the sum value). | > 1 |
Clinical procedure:
- Low-risk group → D-dimer test required; if negative, further diagnosis and anticoagulation may be omitted Cave! This procedure is not safe in the presence of active or treated cancer in the last six months.
- High-risk group → compression ultrasonography required
